Do COVID-19 Apps Address Diabetes Mellitus and Health Equity Issues

Purpose: To evaluate if COVID-19 apps address risk factors such as diabetes, hypertension, race, gender, sexual orientation, language. Background: In 2019, there were 204 Billion app downloads and 3.7 billion downloads of ehealth apps. COVID-19 affects ethnic minority patients with diabetes, hypertension, and other risk factors. Spanish is the second most commonly used language after English in the U.S.. African Americans, Hispanic Americans, and Asian Americans are at an increased risk of COVID-19. LGBTQ+ communities are also at higher risk for COVID due to historically poor access to healthcare. Methods: The search term, “COVID,” in Google Play store and Apple App store was used to find the most popular COVID-19 apps. App inclusion criteria: 1) Contains COVID-19 information and/or COVID symptom tracker, 2) Marketed and designed for the general public, 3) Free, 4) Android (DROID): 100,000+ Downloads; Apple (iOS): highest star ratings. Apple does not provide a number of downloads. App features: COVID-19 information, COVID-19 symptom questionnaire (QN), Diabetes, Hypertension, Cardiovascular disease, Languages (Spanish, Chinese), Race, Gender, and Sexual Orientation. Results: The top 10 DROID apps in descending order are: 1) GuideSafe, 2) CO Exposure Notifications, 3) Care19 Diary, 4) Care19 Alert, 5) Crush COVID RI, 6) MI COVID Alert, 7) DC CAN, 8) CombatCOVID MDC, 9) CombatCOVID PBC, 10) Stronger than C19. The top 10 iOS apps in descending order are: 1) SlowCOVIDNC, 2) COVIDWISE, 3) COVID Alert Pennsylvania, 4) COVID Alert DE, 5) COVID Alert NY, 6) Covid Watch Arizona, 7) Apple COVID-19, 8) COVID Alert NJ, 9) COVID Trace Nevada, 10) CDC. Of the 20 apps: COVID 19 information: 20/20; COVID-19 symptom QN: 8/20; DM: 2/20; HTN: 1/20; CardioVasc: 2/20; Spanish: 11/20 (2/11 of the Spanish apps have Chinese as well). Race: 5/20. Gender: 8/20; Sexual Orientation: 3/20; Age: 10/20. Conclusion: 1) Most apps do not ask about important risk factors such as DM, HTN, and Race. 2) Smartphone apps are not uniform in their health education features. 3) Healthcare providers should continue to play an important role in public education despite the ubiquity of mobile apps.